2018-03-08_PERMIT FILE - M2018010 ‎(4)‎

• Permit No: M2018010
• IBM Index Class Name: PERMIT FILE
• Doc Date: 3/8/2018
• Doc Name: Application
• From: Fremont County
• To: DRMS
• Email Name: TC1
• Email Name: WHE
• Media Type: D
• Archive: No

COLORADO DEPARTMENT OF TRANSPORTATION CDOT Permit:No.
STATE HIGHWAY ACCESS PERMIT _ 21MI _
State Highway No/Mp/Side i
069A/80,2601 Right
Permit Fee Date of Transmittal Region/Section/Patrol/Name Local Jurisdiction
$0,00 06/12/2017 2/041271 Mark Gocha I Fremont Coun
The Permittee(s): The Applicant(s):
A',
Keith Berger Tony Adamic JUL ?�ifr
Bureau of Land Management Fremont County Road Ft Bridge Dept.
3028 East Main Street 1170 Red Canyon Road CDOrRe
Canon City, Colorado 81212 Cahon City, Colorado 81212 Traecy,r, 4�
[phone] [phone]
r
is hereby granted permission to have an access to the state highway at the location noted below.The access shall be constructed"", I-Irm"and used in
accordance with this permit,including the State Highway Access Code and any attachments,terms,conditions and exhibits.This permit may be revoked
by the Issuing Authority it at any time the permitted access and its use violate any parts of this permit.The issuing authority,the Department and their duly
appointed agents and employees shalt be held harmless against any action for personal injury or propetty damaa_e sustained by reason of the exercise of
the permit.
Location: Proposed 1375 ft north of MM 80
Access to Provide Service t0: (I.and Ilse cone) {siae) (units)
991 -Gravel Pit 9 Acres
D --
Additional information: SEE ADDITIONAL TERMS AND CONDITIONS
co Ce—
MUNICIPALITY OR COUNTY APPROVAL
Required only when the appropriate local authority retains issuing authority.
.._ .. _. . --- —. .---_
Signature Print Name Date Title
I
Upon the signing of this permit the permittee agrees to the terms and conditions and referenced attachments contained
herein. All construction shall be completed in an expeditious and safe manner and shall be finished within 45 days from
Initiation. The permitted access shall be completed in accordance with the terms and conditions of the permit prior to
being used.
The permittee shall notify Todd Ausbun with the Colorado Department of Transportation,at [phone] at
least 48 hours prior to commencing construction within the State Highway right-of-way.
The person signing as the permittee must be the owner or legal representative of the property served by the permitted access and have full authority to
accept the permit and its terms and conditions.
Pefmittee S Pratt Name -,I Date
0-ITH E.1EMER
Lc—,
Ittee Sig pplicable) printt�'�ame /J() r _ Data
!L Ions ,F�CI�,�,1 1 (�0I _0
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s mit is not valid until signed by a duly authorized representative of the Department.
LORADO :PA ENT OF TRANSPORTATION
na't Pr, Name Tit! pat (of�
Copy Dtstrfbutl Required: Make copies as necessary for: Previous editions are obsoi a and may not be used
1.Reglon 3.Staff Access Section Local Authority Inspector Page 1 of 3 CDOT Form Ir101 5107
2.Applicant 4.Central Files MICE Patrol Traffic Engineer